Material disadvantages, such as inadequate housing, lack of food, and being uninsured or underinsured, are linked to declines in walking ability and self-rated health among older Americans, according to a new study. Researchers examined data from both the 2004 and 2006 Health and Retirement Study, a national study of Americans aged 51 years and older. They examined walking ability, an important predictor of disability and the need for later long-term care, as well as three factors: health insurance coverage, food insufficiency, and housing quality/affordability.
All three factors contributed to declines in walking ability and self-reported health. Most Americans experienced at least one form of material disadvantage. Individuals with multiple forms of material disadvantage were at particularly increased risk of health decline and functional impairment as they aged. Common problems cited by older persons included issues with neighborhood safety (27.7 percent) and being either uninsured or underinsured (30.9 percent). More blacks (9 percent) than whites (2 percent) were disadvantaged in all three areas of health care, housing, and food. The same was true for 7 percent of participants with less than a high school education compared with 2 percent of those with a high school diploma.
The relationships between health declines and race, poverty, and education were weakened or eliminated when the researchers controlled for material disadvantages. Thus, material disadvantages appear related to health in ways not captured by education and poverty, conclude the researchers. Furthermore, the health effects of material disadvantage were similar to the health effects of comorbid illness. For example, the researchers found that food disadvantage was as strong a predictor of later health declines as heart disease, cancer, stroke, pulmonary disease, or diabetes. They suggest that policies to improve health address a range of basic human needs, rather than health care alone. The study was supported in part by the Agency for Healthcare Research and Quality (HS17003).
See "Material resources and population health: Disadvantages in health care, housing, and food among adults 50 years of age," by Dawn E. Alley, Ph.D., Beth J. Soldo, Ph.D., José A. Pagán, Ph.D. and others in the American Journal of Public Health 99 (Suppl. 3), pp. S693-S701, 2009.